Update 3/25: the American Health Care Act was pulled from the floor and did not go through the voting process. Speaker Ryan has stated that the Affordable Care Act will be the law for the “foreseeable future.” President Trump has since stated that he will wait for the ACA to “explode” and then create a “greater healthcare plan.”

Today, Friday, March 24, 2017, the House of Representatives will vote on the Affordable Care Act replacement bill—the American Health Care Act—with significant changes having been made last night and without the Congressional Budget Office analyzing those changes. Previously the CBO offered projections of, despite a decrease of ~$337 billion in the deficit, roughly 24 million people without coverage by 2026. Even by just repealing the ACA leaves 18 million people uninsured.

The bill underwent multiple changes after receiving severe blowback from all Democrats and several factions of Republicans. GOP moderates felt that the plan was too ill-thought and would leave too many people uninsured. GOP conservatives felt the bill did not go far enough, and dubbed it “Obamacare-Lite.” Those divides postponed the vote, which was supposed to take place yesterday. Ryan and other proponents of the bill did not want to go forward without the votes.

 

The new bill would defund Planned Parenthood. The rationale for this is restriction of abortions. However, Planned Parenthood puts no federal funding towards abortions. They do put federal funding towards reimbursement for services like birth control, contraception, and cancer screenings. Patients use public health programs, like Medicaid and Title X, go to places like Planned Parenthood that take that coverage. They use the programs, Planned Parenthood sends the claim to Medicaid (for example), which reimburses them, and then Medicaid sends the bill to the federal government. Abortions, which account for roughly 3 percent of all PP services, do not get reimbursed.

So when the GOP says that they will defund Planned Parenthood, they are doing it out of spite, because what they’re actually doing is stopping people from being able to use Medicaid for non-abortion services.

Vice President Mike Pence, formerly the Governor of Indiana, recently posted a photo of himself and the President meeting with the Freedom Caucus. The Freedom Caucus is made up of the GOP conservatives who are dragging their feet about the bill.

To get them on the side of voting yes, those in charge of the bill—House Speaker Paul Ryan, VP Pence, and even Trump—have struck a deal with the Freedom Caucus. If the Caucus agrees to the bill, the Essential Health Benefits list will be removed from the bill.

What’s the Essential Health Benefits?

It’s a holdover from the Affordable Care Act. It requires insurances to cover—at the bare minimum—the following 10 items:

• Emergency Services
• Hospitalization
• Ambulatory patient services
• Maternity and newborn care
• Mental health and substance use disorder services
• Prescription drugs
• Rehabilitative and habilitative services
• Laboratory services
• Preventive and wellness services
• Pediatric services

There has been no analysis on the future consequences on striking off the Essential Health Benefits because the CBO has not been given enough time to conduct research.

Trump has put pressure on the GOP to push this bill through. It would solidify his stance as a deal-maker—something he ran on during the campaign—and would show his control over the rapidly dividing Republican party. He has also threatened that the Republicans will lose their majority if the bill does not pass. That pressure has forced massive overhauls to the bill. House Republicans and Democrats are set to vote on a bill that they haven’t read in full, or had sufficient or significant research on.

But perhaps the scariest part of this whole thing is that photo that VP Pence Tweeted out. Him and the President meeting with the Freedom Caucus. With the strength of the Freedom Caucus, the American Health Care Act is that much closer to being passed.

A circle of wealthy, privileged, heterosexual cisgender white men, deciding the fate of women, minorities, cancer patients, those with mental illness, and the vulnerable. We might not have seen the finished bill, but we have seen enough of the consequences. The AHCA would mostly affect the elderly and sick—premiums would rise due to declining assistance—while the young, healthy and wealthy would see tax benefits. In addition, according to Forbes, over the next decade, the plan outlines an $880 billion tax cut, with $274 billion going directly to the richest 2%.

If the AHCA, the new healthcare plan, only benefits the young, healthy and wealthy, while leaving premiums rising, care decreasing, targeting the elderly and the sick, and ~24 million uninsured—then it’s possible that this isn’t the best plan.

But this is the world we live in—the decision of this small cluster of white men, for whom this healthcare plan will only benefit, will impact the rest of us.